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N928 - Basic Principles > Taxonomy of an Anesthetic > Flashcards

Taxonomy of an Anesthetic Flashcards

1
Q

What is anesthesia?

A

amnesia & unconsciousness

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2
Q

5 components of anesthesia

A
  1. amnesia
  2. analgesia
  3. unconsciousness
  4. immobility
  5. areflexia
    →attenuation of ANS response to noxious stimulation
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3
Q

balanced anesthesia triangle is between (3)

A

amnesia, analgesia, muscle relaxation

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4
Q

3 types of anestheisa

A 
Monitored anesthesia care (MAC)
general anesthesia (inhaled or TIVA)
Regional anesthesia 
- topical or infiltration
- peripheral nerve block
- plexus block
- central neuraxial blocks (spinal vs epidural)
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5
Q

managing an anesthetic has 6 steps

A
  1. preparation
  2. pre-induction
  3. induction
  4. maintenance
  5. emergence
  6. post-op
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6
Q

types of positioning equipment (7)

A
  • head rest
  • arm boards/pads
  • prone pillow
  • axillary roll
  • extra pillows/padding
  • eye pads/lubricant
  • anesthesia circuit extenders
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7
Q

Medication label should include:

A
  1. drug name
  2. concentration
  3. date
  4. time
  5. initials
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8
Q

2 common medication errors

A
  1. administration of muscle relaxant when reversal was intended
  2. misidentification of same color label
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9
Q

Medication types needed for induction (3)

A
  1. anxiolytics
  2. narcotics
  3. induction agent
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10
Q

Emergency drugs to prepare:

GAPEES

A 
\+/- Glycopyrrolate 
Atropine [0.4mg/mL or 1mg/mL]
Phenylephrine [100mcg/mL]
Ephedrine [5mg/mL]
Epinephrine [+/- draw up; in cart]
Succinylcholine [20mg/mL (10mL)]
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11
Q

Steps prior to surgery (5)

A
  1. preop visit
  2. preop orders
  3. preop note
  4. consults
  5. anesthesia care plan
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12
Q

Pre-Op visit; 6 steps

A
  1. identify surgical procedure
  2. medical history
  3. physical exan
  4. assign ASA physical status classification
  5. develop “care plan” & anesthetic technique
  6. document informed consent & pre-op note
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13
Q

Pre-Op orders

A
  1. tests as indicated
  2. NPO
  3. Any pre-medications [continues/ERAS protocol, insulin?]
  4. special procedures [start IV, check quick labs; glucose, istat]
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14
Q

in the holding area (9 steps)

A
  1. greet pt & family
  2. identify pt
  3. reaffirm surgery & site
  4. interview & reassess
  5. airway assessment & planning
  6. review chart for changes since full interview
  7. formulate anesthetic plan
  8. obtain consent
  9. lines (PIV, invasive monitoring)
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15
Q

When choosing the anesthetic basics (3)

A

should be patient specific

  • promote stability and + patient outcome
  • adapt plan to consider patient and surgical needs such as: anatomical/physical findings, functional status, pt medical & surgical history, surgical considerations
  • Plan A, B, C
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16
Q

Specific considerations when making an anesthetic plan:

A
  1. pt current physical condition
  2. type and site of surgery
  3. surgical position
  4. costs (equipment)
  5. elective or emergent surgery
  6. NPO status
  7. patient biases
  8. surgeon skill level
  9. anesthetists’ skill & preferences
17
Q

Goals for any pharmacological pre-medications

A
  • anxiolysis
  • sedation
  • analgesia
  • amnesia
  • antisialagoue effect
  • antiemetic
  • increase gastric fluid pH
  • decrease gastric fluid volume
  • allergic prophylaxis
  • antimicrobial protection
18
Q

Steps of induction (6)

A
  1. preoxygenate/denitrogenate with 100% O2
  2. reconfirm surgery and type of anesthesia
  3. “sweep” monitors & equipment (*SUCTION)
  4. administer medications [hypnotic, narcotic, induction agent]
  5. confirm unconsciousness, apnea, position head, attempt to mask ventilate
  6. muscle relaxant
19
Q

Rapid sequence induction

A
  • patient’s considered full stomach
    [violated NPO, pregnancy, trauma, cirrhosis, obesity, GERD, GI pathology]
  • *SUCTION MUST BE READILY AVAILABLE
  • *DO NOT MASK VENTILATE
  • cricoid pressure applied as induction agent is administered
  • CP maintained until ETT placement confirmation is made

aspiration pneumonitis has high morbidity/mortality

20
Q

Maintenance stage 3 components

A
  1. inhalation agent
  2. Intravenous agents [narcotics, benzodiazepine, sedation, muscle relaxant]
  3. fluids [maintenance, deficit, third space, blood loss]
21
Q

Maintenance phase begins & ends…

A

begins post-induction, ends prior to emergence

  • many techniques
    1. O2 w/ vol agent
    2. +/- N2O
    3. Narcotics
    4. muscle relaxants
    5. TIVA
22
Q

Intraoperative management MAIN POINT

A

**VIGILANCE; evaluate pt’s response to surgery & anesthetic

23
Q

intra-op anticipate…

A
  • surgical stimulus, bleeding, medication limits
  • fluid management & replacement
  • monitor blood loss and replace as necessary
24
Q

AANA Standard #7

A

anesthesia plan implementation & management

25
Q

AANA Standard #5

A

accurate record keeping

26
Q

Emergence

A

Reversal; inhalation, agent narcotic, relaxant, sedation → extubation → PACU

27
Q

How to time extubation; know 3 things

A
  1. experience
  2. familiarity with surgeon
  3. alert for clues
28
Q

for extubation, ensure anesthetics are

A

discontinued or reversed

29
Q

extubation preparation; ensure patient is placed on _____ & allow pt to ____

A

appropriate O2 concentrations;

breathe spontaneously

30
Q

before extubation; ____ criteria should be met

A

extubation

31
Q

after extubation ensure ____ & ____ maintatined

A

airway & spontaneous ventilation

32
Q

7 reasons for failure to emerge

A
  1. residual NMBD
  2. excessive opioid or benzodiazepine
  3. intraoperative CVA
  4. pre-existing pathophysiological conditions
  5. electrolyte abnormalities
  6. acidosis
  7. hypothermia
33
Q

before transporting to PACU:

A
  • stabilize patient in the OR
  • vigilance in monitoring
  • transport O2 as appropriate
  • safe hand-off to qualified professional / PACU nurse
34
Q

PACU report includes:

A
  1. Pt Hx
  2. surgical procedure
  3. anesthetic
  4. intraoperative course
  5. fluid status (EBL; I&O)
35
Q

What’s next after transferring patient to PACU?

A
  • recheck machine
  • clean anesthesia work station
  • ## set up OR for next case

N928 - Basic Principles (22 decks)

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